The human spine is made up of 26 bones. In between these bones are discs filled with gel-like material. They are soft and rubbery, and make back flexibility possible. The discs function as a shock-absorber to the bones and protect them from damage. When there is discomfort and pain in the lower back or neck, perhaps due to an injury, it may be because of a herniated disc or slipped disc.
This happens when the jellylike disc ruptures or gets damaged. When the disc leaks, it affects and irritates the nerves that are close to it, causing back and/or neck pain. In minor cases, the doctor will only prescribe anti-inflammatory and pain medication, which relieve symptoms of inflammation and soreness. Serious cases require further assessment as well as treatment, like physical therapy or surgery.
Types of slipped discs
The different kinds of ruptured discs are classified according to where they are found. The common types are:
Thoracic – located between any vertebrae pair/s among the 12 in the middle back
Lumbar – located between any pair/s among the 5-6 in the lower back
Cervical – located between any pair/s among the 7 in the neck
Out of the three, lumbar herniated disc is the most common, since the lumbar spine is the most overused part of the body, bearing weighty load and various movements. Apart from lower back soreness, patients may also experience numbness, muscle weakness, and tingling sensations.
The fairly common cervical herniated disc can affect not just the neck, but also the hands and arms; the source of several nerve roots of the upper limbs are located in the cervical vertebrae.
The rarest of the types is the thoracic herniated disc. The bones of the thoracic spine are connected to the ribcage, and it does not require a lot of movement compared to the cervical and lumbar spines. Despite its unusual occurrence, it can still cause soreness in the torso and upper back.
Disc herniation comes with ageing and degenerative disc disease (pain and weakness from a degenerated disc in the spine). As the degeneration occurs, the rubbery centre (nucleus pulposus) and outer fibrous ring (analus fibrosus) of the disc are at risk of altered loads (departure from normal body content). The former becomes stiff, making it less flexible, and the latter can develop fissures due to the increased load that it’s unable to bear. Once the fissures damage the outer part of the annulus, the nucleus leaks and triggers the condition.
Aside from ageing and degeneration disease, a herniated disc is also an effect of wear and tear. Exerting too much physical effort, such as heavy lifting and extreme workouts, can result in disc herniation. Athletes who play contact sports, and even people who exert less physical activity or resort to a sedentary lifestyle, are prone to this ailment.
A young person’s discs contain almost 80% of water. As he/she grows old, the water content lessens, rendering the discs subject to wear and tear. Other factors that can produce such problems are: excessive body mass, smoking, repetitive twisting activities, and traumatic injury.
Indications will depend on the kinds of soft tissue involved and area of the herniation. When only the tissue is affected, there is little or no pain at all. But when the nerve roots are involved, a patient can suffer severe lower back or neck pain.
Sometimes a ruptured disc can’t be diagnosed immediately because the symptoms are similar to other medical conditions. These include pain in the feet, knees, and thighs; sometimes tingling sensations, weakness, or numbness also occur. If the herniation is anywhere within the torso area, it could affect the sciatic nerve, which then causes sciatica – pain that starts in the lower back and down to the thighs and knees. Other symptoms in the lower back include: burning soreness centred in the back of the neck, weakness in the left or right leg, and no bowel or bladder control.
The herniation also affects the upper part of the body, specifically the neck. A patient can experience pain in the trapezius muscles, the muscles between the shoulder and neck. Its symptoms are similar to those in the lower back. But instead of affecting the lower limbs, herniation pain in the neck affects the upper limb function.
Yet unlike other conditions such as muscle spasm, which indicate pulsating pain, disc herniation has continuous discomfort in a particular location. Sometimes patients can’t tell if they have a herniated disc because of some unnoticeable symptoms.
When the pain or weakness becomes intolerable and spreads down to both arms and/or legs, medical attention is badly needed.
Risk factors are things that can increase a person’s chances of developing a condition. Some of these factors can be changed while others cannot.
Generally, getting old and a history of back injury, back surgery, or herniated disc, are inevitable factors of a herniated disc; there’s nothing that can be done to reverse them. But there are some changeable risk factors of lumbar, cervical, and thoracic slipped disc, such as:
Repetitive physical movements, like sitting down and then standing up again and certain exercise routines
Pulling and lifting heavy objects
Exposure to vibrations, like when driving
Extreme physical exertion, such as weight lifting exercises
Twisting and bending
While engaging in physical activities and daily exercise are encouraged to flex the body and keep it in shape, overdoing such activities will put it at risk of a ruptured disc. In the same way, not doing any form of exercise, even just minor activities like walking and jogging, will also make the spine prone to the condition.
Being overweight means carrying additional mass to support. There is limited movement and flexibility of the body. It may add tension to the lower back, especially when there is more weight around the belly.
A bad habit like cigarette smoking can affect the bones, because the nicotine and toxins that come from the tobacco and smoke, respectively, hinders the discs from absorbing nutrients needed for the blood. This weakens the discs and makes the spine prone to injury.
Like the lumbar slipped disc, cervical and thoracic herniated disc risk factors include smoking, poor diet, being overweight, obesity, and inadequate exercise. In addition, making a habit of improper body mechanics and poor body posture can stress the upper as well as the lower portion of the vertebral column.
There are two types of herniated disc treatment: surgical and nonsurgical.
In serious cases, like when a disc fragment has lodged in the spinal canal and puts pressure on the nerves, surgery will be needed. Without undergoing a surgical procedure, a certain part/s of the body, such as the upper or lower limb/s, will stop functioning. The kind of procedure done in the lower back (laminectomy or microdiscectomy/microdecompression) will depend on the size and location of the rupture.
An anterior cervical discectomy and fusion are normally done in the neck. The damaged disc will be removed, taking the pressure off the nerve roots and spinal cord. Bone will be used to replace the disc and metal to stabilise the spinal column.
Nonsurgical treatments, which is the more common treatment, involve plenty of rest, less strenuous, physical activities, daily pain, muscle relaxer, and anti-inflammatory medication intake, and cold and hot compresses not more than 20 minutes several times a day.
In July 2014, medical professionals in the Toronto, Vancouver, and London area in Canada announced that they were trying out an experimental procedure to treat disc herniation using a mechanism called AO-1000; it takes oxygen, converts it to ozone gas, and injects it to the ruptured disc.
According to the inventor of AO-1000 Dr. Kieran Murphy, a University Health Network radiologist in Toronto, the gas helps shrink the damaged disc and prevents it from irritating the nerves.
The procedure is said to take only less than an hour, and would be a better alternative to expensive surgical treatments. But further tests would still have to be performed to confirm its effectiveness in treating the condition.
Despite the effective treatments available today, it’s always best to reduce the risks of ruptured discs beforehand. But when you’re already experiencing chronic back or neck pain, make sure to see a health specialist as soon as possible. Avoid having to take the harsh treatments by getting diagnosed early on. Keep in mind that an ounce of prevention is worth a pound of cure.